By Matthew Taylor, chief executive of the NHS Confederation

Last week I took a trip to Warwickshire to talk to local authority and health leaders about the challenges and opportunities of reform. It was my first trip to the old Shire Hall in Warwick since I was a county councillor more than three decades ago. My four years as part of a minority Labour administration there gave me an appreciation for local government which has never left me.

If I was a councillor now, I could have several reasons to resent my colleagues in health. I might view the NHS's recent Budget settlement with envy – even though it hardly covers this year's pay awards and deficits and its value next year is dependent on pay reviews. I might be irritated by the tendency among some to blame NHS patient flow problems on gaps in social care and forget that such care is about more than getting folk out of hospital. I might echo the view of colleagues in the community and voluntary sector, that the NHS is not always the most generous or flexible of local partners. 

But if that was how I felt, however justified, I hope some wise friend would tell me to get over myself. Because when we look up from the irritations and squabbles (although in most places I visit, relations between NHS and local government are encouragingly resilient and positive), we need to understand the very big and very threatening picture. 

As I've written before, if we can't bend downwards the medium-term demand curve for healthcare, we are pretty much doomed to national decline and all the social instability and political polarisation such a decline would likely bring in its wake. 

The key to addressing this challenge is as simple to express as it is hard to accomplish: we need to help people stay healthier for longer. To do this requires the three shifts that health and social care secretary Wes Streeting has put at the centre of his reform strategy – a step change in the prevention of illness, a transformation of models of care and the full utilisation of the immense and growing power of technology.

This in turn requires transformation, not just in parts of what we do but in the whole model. We need to accomplish major change in everything from public norms and behaviours to funding systems and pathways by which people access services. But this transformation – the most significant in the NHS's 80-year history – will have to proceed without transformative funding.

Anyone analysing this dispassionately would say our chances of success are exceedingly slim. It may be time to adopt the mindset that Italian Marxist Antonio Gramsci recommended from jail to his followers: ‘Pessimism of the intellect, optimism of the will.' No-one should underestimate the challenge, but we have no choice but to throw ourselves into it. 

There is one important upside to the inability of this Labour Government to throw large sums of money at reform, as the last one did. It is leading to recognition in Whitehall, first, of the need to promote radical experimentation in systems and places and, second, of the centre itself to shift from a mode of control to one of enablement. This doesn't mean a free-for-all with ministers abandoning national pledges. But if local leaders can come up with concrete, credible and ambitious plans to embark on the journey to a healthier population, then politicians are listening.

I don't remember that much about my Warwickshire years, but I am proud of the one big area of reform on which I focused; a shift in the way the county approached special needs provision.

I have no doubt that with the support for central Government, both in terms of acting on the national dimensions of prevention and creating the space for local innovation, there is the scope to do things very differently. Now is the time locally to put aside past irritations and current border skirmishes and to think big and act bold. Together we can prove that necessity really is the mother of invention.